Management of Pre-invasive Cervical Cancer in Low-Resource Setting
Saibua B Chichareon MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University
Cervical cancer is one of the health burdens in many developing countries. The advanced knowl-
edge in the past decade reassured the important role of human papillomavirus as the necessary cause of
cervical cancer and makes a clear understanding of its natural history.
Cervical cancer has a long period of pre-invasive stage, and only a small proportion of cervical
intraepithelial neoplasia (CIN) that can progress to be an invasive lesion. Appropriate management of CIN
can prevent invasive cervical cancer. The contemporary treatment of CIN is more conservative and requires
effective follow-up process. However inappropriate management of CIN is still be found at the international
and national survey of less developed countries.
Although no apparent superior surgical technique for treating CIN, loop electrosurgical excision
procedure (LEEP) and cryotherapy are fascinated for the low-resource setting. Other alternative approach,
which eliminates cytology and colposcopy may be considered in the ultrashort- resource setting with a high
prevalence of cervical cancer.
In this article, the contemporary knowledge about the natural history of cervical cancer, especially
the implication of human papillomavirus (HPV) for pre-invasive cervical cancer, is summarized. The current
approaches for treatment of CIN are reviewed from the perspective of low-resource settings. The various
strategies for management approaches are demonstrated, and the cost-effectiveness is discussed. The pattern
of pre-invasive cervical cancer management in developing countries, including in the south of Thailand is
exhibited, and the single-visit service for cervical cancer prevention in the northeast is challenged.
Keywords : Cervical, Pre-invasive, Low-resource setting
